Surgical retractor system

ABSTRACT

The present invention provides an improved surgical retractor system useful for holding tissue away from a surgical site during a medical or dental procedure. In one embodiment, the surgical retractor system is comprised of a tubular member, such as a cannula, and a retractor member. In an embodiment, the retractor member may be ring shaped. The retractor member preferably may have an opening therethrough for receiving the cannula. An engaging member associated with the retractor member may be provided for rotatably engaging the cannula. In one embodiment, the cannula may have external threads that are releaseably engaged with the engaging member and allows the degree or amount of tissue retraction to be adjusted. The cannula may be configured to be used with and secured to a handle to facilitate using the retractor system. A method of using the retractor system is also disclosed.

CROSS-REFERENCE TO RELATED APPLICATIONS

This is a continuation-in-part of U.S. patent application Ser. No.09/742,254 filed Dec. 20, 2000, entitled “Universal Handle,” which isincorporated herein by reference.

BACKGROUND OF THE INVENTION

The present invention generally relates to surgical instruments used insurgical procedures, and more particularly to an improved handle thatpermits various instruments to be releaseably attached for quicker andeasier interchange.

The development of newer minimally invasive surgical techniques, such aslaparoscopic surgery, have allowed surgeons to successfully performnumerous operative procedures in many instances which in the pastrequired the need for large surgical incisions. In this newer procedure,one or several very small incisions are made in the patient throughwhich various surgical instruments may be used to perform the requiredsurgical procedure. Minimally invasive surgery offers benefits whichinclude creating less trauma to the patient, reducing the risk ofpost-operative infections, and allowing speedier recovery thanconventional surgery with its larger incisions.

Trocars are commonly used in minimally invasive surgeries. Theygenerally consist of a hollow cannula (tube) and an obturator (bladed orpointed piercing device) which are used, in combination, to make a smallportal into a patient. The obturator is designed to slide inside thecannula to create a single unit that may be used to penetrate a smallincision that has been previously made by a surgeon. Once the trocar haspenetrated the patient's body cavity, the obturator is withdrawn whileleaving the cannula in position. Various surgical instruments can thenbe worked through the cannula to perform whatever surgical technique isrequired.

Trocars are particularly useful in many types of surgery in which asmall incision will permit the required surgical procedure to becompleted. One such application is in maxillofacial surgery where bonefractures occurring in the maxilla or mandible are stabilized by bonescrews and/or bone plates. In this trocar application, drill guides canbe inserted through the cannula which allow the surgeon to pre-drillholes in the bone for receiving bone screws. Trocars can also be usedwith soft tissue retractors, such as cheek retractors which are employedto hold the tissue away from the surgical site so that it does notinterfere with fixation of the facial fracture.

The cannula may be fastened or secured to a handle of some type. Thishelps the surgeon control the trocar and facilitates the process of bothmaking the initial incision accurately and subsequently working withvarious instruments in a manner which reduces the chance of the cannulabeing pulled from the patient's body cavity prematurely.

Handles of the past have typically employed various approaches forcoupling the cannula to the handle. For example, cannulas were oftenattached in a permanent manner to the handle such as by welding.Semi-permanent type couplings have also been used such as threading thecannula head to the handle, or providing set screws to hold both partstogether. U.S. Pat. No. 5,755,721 to Hearn discloses anothersemi-permanent type of coupling wherein a retaining ring with aninternal depression around its circumference is provided that mates witha spring and ball detent on a surgical instrument. The instrument ispushed into the retaining ring until the detent is seated in thedepression.

The handle designs of the past have several drawbacks. The permanenttype attachment does not allow the surgeon to interchange differentkinds or sizes of surgical instruments. This reduced flexibility for thesurgeon and increased prices for each trocar unit which must containboth a handle and permanently affixed cannula. Overall inventory costsare thereby also increased.

Although the semi-permanent type couplings offer interchangeability ofsurgical instruments, they too have been problematic. Using set screwsor threaded coupling of the cannula to the handle makes changinginstruments cumbersome, especially when it must be done during theexigencies of a surgical procedure. While offering improvement, thecoupling described in the Hearn patent does not positively lock thecannula to the handle in a manner that requires the surgeon to unlockthe cannula from the handle.

Accordingly, there is a need for a handle which allows for improvedreleaseability and interchangeability of various surgical instrumentswith the handle while overcoming the problems associated with theforegoing prior art devices.

Retractor members, which in some embodiments may be ring-shaped, may beused to withdraw or hold soft tissue away from a surgical site toprevent injury to the tissue not directly affected by the surgicalprocedure. For example, a retractor member is sometimes used inmaxillofacial medical and dental procedures to retract the cheek of apatient to repair jaw bone fractures by drilling holes in the damagedbone and implanting bone screws, sometimes in combination with boneplates. Retractor members may be mounted on a tubular member, such as acannula. The cannula may be inserted through an incision in thepatient's cheek and the retractor member is inserted through a second orother bodily opening, such as the mouth or second incision, and thenaffixed onto the cannula. The cannula/retractor member combination,however, has proven difficult for the surgeon to assemble and adjust insitu during the surgical procedure.

BRIEF SUMMARY OF THE INVENTION

The invention is generally directed to a handle and system of surgicaltools which can be designed specifically to be compatible andinterchangeable with the handle.

In accordance with one embodiment, the handle is comprised of a graspingportion and a handle lock assembly. The grasping portion is used by thesurgeon to hold and control the handle. The handle lock assemblycomprises a body with a top and a bottom, and further includes aretractable slider pin which secures a surgical instrument to thehandle.

In another embodiment, the lock assembly body includes an openingdisposed in the body through which surgical instruments are inserted.The opening, which is preferably circular in one embodiment, extendsfrom the top to the bottom of the lock assembly body creating an openingpassing completely through the body. The retractable slider pin ismovable from an extended position in which the pin protrudes into theopening and secures the surgical instrument to the handle, to aretracted position in which the pin is withdrawn from the opening.

The slider pin may be connected to a handle slider which is preferably arectangular or square block in configuration, but is not limited tothose shapes. The slider pin may be integrally connected with the handleslider such as by welding or the slider pin and handle slider may beformed as an integral unit. Also preferably, the handle slider isslidably mounted in a cavity or other opening provided in the body ofthe handle lock assembly. Alternatively, the handle slider may bemounted on the exterior of the handle lock assembly which is a matter ofdesign choice.

In one embodiment, the handle lock assembly of the handle includes atleast one handle release. The handle release is used to move theretractable slider pin from the extended position to the retractedposition as discussed above. The handle release is connected to thehandle slider which is connected to the slider pin, thereby moving thepin.

In accordance with another embodiment, at least one biasing member isprovided which biases the slider pin toward its extended position.Preferably, the biasing member is a helical spring. In one embodiment,the biasing member may be held by a recess provided in the handleslider. The handle lock assembly may be attached to the grasping portionof the handle by welding. The handle including the grasping portion andhandle lock assembly may be made of stainless steel, however, it may bemade of any material suitable for the intended application. The graspingportion of the handle may be hollow which reduces the cost and weight ofthe handle.

In accordance with one embodiment, the surgical instrument that may beused with the handle of the invention is a cannula or trocar assembly.The cannula, or different instrument as the case may be, may includeindentations which are designed to engage the retractable slider pinthereby securing the cannula to the handle. Preferably, the cannula ordifferent instrument may further include additional depressions whichmay be used to secure at least one additional surgical device to thehandle. In one embodiment, a soft tissue retractor is an additionaldevice that may be attached to the handle. Preferably, the cannula ordifferent instrument, and additional devices that may be attached to thehandle may be made of stainless steel, however, they may be made of anymaterial suitable for the intended application. The cannula or differentinstrument may further include a body portion and a head portion, andpreferably where these two portions are of different size diameters, aninclined ramp may be included between the two portions to facilitateinsertion of the cannula into the handle as discussed below. The cannulaor different surgical instrument may further comprise a knob connectedto the cannula or different instrument for grasping and rotating thecannula or different instrument. At least one slot may be provided inthe knob for mating and engaging with at least one tab provided on asurgical instrument intended to be inserted through the cannula ordifferent surgical instrument secured to the handle to prevent rotationof the inserted instrument in the cannula or different instrument. Anobturator or a drill guide which are well known in the art may be suchan instrument provided with at least one tab which mates with the atleast one slot in the knob of the cannula or different instrument.

In another embodiment, the handle lock assembly body of the handle mayinclude a transition portion between the handle lock assembly and thegrasping portion. The grasping portion preferably may be angularlydisplaced, preferably about 30 degrees, from the plane of the top of thehandle lock assembly.

A handle lock system for performing a surgical procedure is alsoprovided. The system may comprise a handle which has a grasping portionand handle lock assembly. The lock assembly comprises a body with a topand a bottom, and a retractable slider pin. The system further mayinclude a cannula or different instrument having indentations to engagethe slider pin thereby securing the cannula to the handle. In oneembodiment, the handle lock system may further include additionaldepressions for securing an additional surgical instrument to the trocarhandle. Preferably, the additional surgical instrument may be a softtissue retractor.

A method of interchangeably using surgical instruments in a handle lockassembly, and a trocar specifically, is also provided, which maycomprise the steps of: (a) providing a handle, the handle having agrasping portion and a lock assembly, the lock assembly comprising abody with a top and a bottom, a retractable slider pin, and a passagewaydisposed in the body wherein the surgical instruments are inserted forsecuring to the handle, the retractable slider pin being movable from anextended position in which the pin protrudes into the passageway to aretracted position in which the pin is withdrawn from the passageway,(b) providing a cannula having indentations to engage the retractableslider pin thereby securing the cannula to the handle; (c) inserting thecannula in the handle; (d) locking the cannula to the handle by engagingthe retractable pin in one of the indentations; (e) retracting theretractable pin from the extended position to the retracted position;and (f) removing the cannula from the handle. The method may compriseinserting a different surgical instrument having indentations into thepassageway other than a cannula. The method may further includeinserting an obturator into the cannula.

In another embodiment of the method, locking the cannula or differentsurgical instrument to the handle may further include the steps ofwithdrawing the slider pin from the passageway to the retracted positionby a user and inserting the cannula or different instrument into thepassageway before the slider pin engages one of the indentations. Themethod may also further include the step of rotating the cannula ordifferent instrument to align the indentations and sliding pin to lockthe cannula or different instrument to the handle.

The present invention provides an improved surgical retractor systemuseful for holding tissue away from a surgical site during a medical ordental procedure. In one embodiment, the surgical retractor system iscomprised of a tubular member, such as a cannula, and a retractormember. In an embodiment, the retractor member may be ring shaped. Theretractor member preferably may have an opening therethrough forreceiving the cannula. An engaging member associated with the retractormember may be provided for rotatably engaging the cannula. In oneembodiment, the cannula may have external threads disposed on at least aportion thereof that are rotatably and releaseably engaged with theengaging member and allows the degree or amount of tissue retraction tobe adjusted. The cannula may be configured to be used with and securedto a handle to facilitate using the retractor system.

In accordance with one embodiment, the tubular member preferably hasthreads and the engaging member of the retractor member engages thethreads on the tubular member to adjust the position of the retractormember along the axial length of the tubular member. The engaging membermay be disposed in a bore in the retractor member that extends from theretractor member's outer surface to and in communication with theopening in the retractor member which receives the tubular member.

In an embodiment, the engaging member may have a blunted tip protrudingat least partially into the opening of the retractor member for engagingthe external threads of the tubular member. In another embodiment, theengaging member may comprise a screw and the retractor member may have athreaded hole communicating with the opening of the retractor member forreceiving the tubular member. The screw preferably is disposed in thethreaded opening. In yet another embodiment, the engaging membercomprises threads disposed on the retractor member adjacent the openingfor receiving the tubular member, and the threads of the retractormember are engageable with the threads of the tubular member. In anotherembodiment, the engaging member is a pin.

In one embodiment, the tubular member is a cannula. In anotherembodiment, the retractor member is shaped substantially like a ring.The retractor member may have at least one hole configured to be engagedby at least part of a surgical instrument or tool for manipulating theretractor member.

A cheek retractor system is provided which may comprise a cannula havingthreads disposed on at least a portion of the cannula, a retractormember having an opening therethrough for receiving the cannula, and anengaging member associated with the retractor member. The engagingmember may rotatably engage the cannula. In one embodiment, the cannulacomprises a distal end and a proximal end. A window may be provided atthe proximal end of the cannula. The window may be used for facilitatingobservation and/or irrigation of the surgical site.

In one embodiment, the retractor member has a top surface, a bottomsurface, and a side surface. The retractor member may further compriseat least one hole extending at least partially through the side surfacefor engaging part of a surgical instrument or tool used to manipulatethe retractor member. In another embodiment, at least two such holes maybe provided for engaging a surgical instrument or tool. A hole extendingfrom the top surface to the bottom surface of the retractor member mayalso be provided for manipulating the retractor member.

A system for retracting tissue is provided comprising a cannula havingan external surface and an axial length. At least a portion of thecannula may have external circumferential threads. A retractor membermay be included in the system and have an opening configured to receivethe cannula therethrough, and an engaging member associated with andprotruding at least partially into the opening for engaging the threadson the cannula. The retractor member may be adjustable along the axiallength of the cannula.

A handle may also be provided with the system which is configured toreleasably secure the cannula to the handle. The handle may have aretractable slider pin for securing the cannula to the handle. Thecannula may have a circumferential groove configured and adapted toengage the slider pin. In one embodiment, the cannula may be capable ofbeing rotated while being secured to the handle. In another embodiment,the groove prevents the cannula from moving axially along itslongitudinal length while the pin is engaged with the groove.

A method of retracting tissue for a surgical procedure is providedcomprising the steps of: providing a cannula having a distal end and aproximal end; providing a retractor member having an openingtherethrough for receiving the cannula, the retractor member having anengaging member for engaging the cannula; inserting the cannula througha first bodily opening; inserting the retractor member through a secondbodily opening; guiding the distal end cannula into the opening of theretractor; and rotating the cannula or the retractor member to engagethe retractor member and the cannula. The tissue may be adjustablywithdrawn from the distal end of the cannula. In one embodiment, theretractor member and the cannula are rotatably engaged. In anotherembodiment, the method further comprises the cannula having an externalsurface with circumferential threads disposed on at least a portion ofthe external surface and the retractor member further comprises threadsdisposed on a surface of the retractor member surrounding the openingfor receiving the cannula. In one embodiment, the cannula is rotated tothreadably engage the retractor member and the cannula. In anotherembodiment, the retractor member is rotated to threadably engage theretractor member and the cannula. In another embodiment, the firstbodily opening is an incision in the tissue of a patient and the secondbodily opening is a second incision in the tissue of a patient. In yetanother embodiment, the first bodily opening is an incision in thetissue of a patient and the second bodily opening is the mouth of apatient.

A retractor kit is also provided comprising: a cannula having externalthreads on at least a portion thereof and a retractor member having anopening configured and adapted to receive the cannula. The retractormember may have an engaging member that is engageable with the externalthreads of the cannula. The kit may also include a handle having agrasping portion and a handle lock assembly for holding the cannula.Rotation of the tubular member or the retractor member rotatably engagesthe retractor with the tubular member. An obturator may also be providedin one embodiment that is configured and adapted to be inserted into thecannula.

It will be appreciated that the tissue retractor is particularly usefulfor maxillofacial surgical procedures. However, use of the tissueretractor is not limited to maxillofacial surgery alone and it may beused with and in any type of medical or dental procedure where it isdesirable to releaseably attach medical or dental instruments to ahandle.

BRIEF DESCRIPTION OF THE DRAWINGS

The features and advantages of the present invention will become morereadily apparent from the following detailed description of theinvention in which like elements are labeled similarly and in which:

FIG. 1 is a side elevation view of the handle of the present invention;

FIG. 2A is a side elevation view of the handle lock assembly of thehandle of FIG. 1 shown with the handle release removed;

FIG. 2B is a bottom plan view of the handle lock assembly of the handleof FIG. 1 shown with the handle release removed;

FIG. 2C is an isometric view of the handle lock assembly of the handleof FIG. 1 shown with the handle release removed;

FIG. 2D is a plan view of the handle slider of the handle lock assemblyof the handle of FIG. 1;

FIG. 2E is a view of the slider pin of the handle lock assembly of thehandle of FIG. 1;

FIG. 2F is an isometric view of the handle release of the handle lockassembly of the handle of FIG. 1;

FIG. 2G is a top cross-sectional view of the handle lock assembly of thehandle of FIG. 1;

FIG. 3A is a plan view of a cannula which may be used interchangeablywith the handle 1 of FIG. 1;

FIG. 3B is a 90 degree rotated plan view of the cannula of FIG. 3A;

FIG. 4A is a top plan view of a soft tissue C-retractor which may beused with the handle of FIG. 1 shown with the sliding C-retractorreleases partially removed;

FIG. 4B is a side elevation view of a soft tissue C-retractor which maybe used with the handle of FIG. 1;

FIG. 4C is an isometric view of a soft tissue C-retractor which may beused with the handle of FIG. 1;

FIG. 5 illustrates the cannula of FIGS. 3A & 3B with an insertedobturator which may be used with the handle of FIG. 1;

FIG. 6 is a side elevation view of the handle of FIG. 1 with an insertedcannula and obturator,

FIG. 7 is a side elevation view of a tissue retractor member which maybe used with a cannula that may be used interchangeably with the handleof FIG. 1;

FIG. 8 is a cross-sectional top view of the tissue retractor member ofFIG. 7;

FIG. 9 is a cross-sectional side view of the tissue retractor member ofFIG. 7;

FIG. 10 is an isometric view of the tissue retractor member of FIG. 7;

FIG. 11 is a side view of a screw that may be used with the tissueretractor member of FIG. 7;

FIG. 12 is an end view of the screw of FIG. 11;

FIG. 13 is a partial cross-sectional side view of the tissue retractormember of FIG. 7 showing a pin or screw that may be used with theretractor;

FIG. 14 is a cross-sectional side view of a cannula that may be usedwith the tissue retractor member of FIG. 7;

FIG. 15 is a side elevation view of a cannula that may be used with thetissue retractor member of FIG. 7;

FIG. 16 is a partial cross-sectional top view of a tissue retractormember having a threaded opening;

FIG. 17 is a cross-sectional side view of the tissue retractor member ofFIG. 16;

FIG. 18 is a cross-sectional partial side view of the threads of thetissue retractor member of FIG. 16;

FIG. 19 is a isometric view of the tissue retractor member of FIG. 16;and

FIG. 20 is a side elevation view showing a tissue retractor memberinstalled on the cannula of FIG. 14.

DETAILED DESCRIPTION OF THE INVENTION

Referring to FIG. 1, the handle 1 is depicted in one embodiment asincluding a handle lock assembly 2 and a grasping portion 3. Handle lockassembly 2 may include a transition portion 4 connected to graspingportion 3 as shown; however, lock assembly 2 may be attached directly tograsping portion 3 with minimal or no transition depending on the shapeand design of the handle 1 desired. It will further be readily apparentthat the shape of the grasping portion 3 is a matter of ergonomic designchoice and is not limited to the embodiment shown. Furthermore, graspingportion 3 may be formed of one or more pieces secured together in anymanner commonly used in the art (e.g., welding, set screws, etc.) andmay be either solid or hollow. It will also be appreciated that thesize, shape, and position of the lock assembly 2 on the grasping portion3 is a matter of design choice and is similarly not limited to thepreferred embodiment shown.

FIGS. 2A-2G depict the handle lock assembly 2 of the handle 1 in moredetail (for clarity, the same numerical designations are used for sameparts in every figure contained herein). Referring to FIG. 2A, thehandle lock assembly 2 comprises a body 7, a retractable slider pin 5,and a handle slider 6 which is slidably mounted within a cavity providedin body 7. Preferably, handle slider 6 is a rectangular or square blockin which various recesses have been made to accommodate other componentsof the handle lock assembly 2 (best seen in FIG. 2D). Pin 5 (FIG. 2E) isrigidly connected to handle slider 6, preferably by press fitting thepin into recess 40 provided in slider 6 (FIG. 2D). Alternatively, thepin S may be attached to the handle slider 6 in any manner commonlyknown in the art, and may in fact be an integral part of the slider 6formed during manufacture of the slider. Pin 5 as shown preferably hasrounded edges to facilitate engaging the indentations provided insurgical instruments as will be described below.

Referring to FIG. 1 and best seen in FIGS. 2F & 2G, a sliding handlerelease 9 is provided in the preferred embodiment shown which isU-shaped and wraps around the bottom of the handle lock assembly body 7.Handle release 9 has a base 47 with sidewalls 48 projecting upwards andconnected to the base. In one embodiment shown, handle release 9 has aflattened surface 45 which mates with and slides on a flat landing 44(FIG. 2B) formed or machined on the body 7 of the handle lock assembly2. Handle release 9 may be attached to each side of the handle slider 6in any number of ways commonly used in the art. For example, the handlerelease 9 may be attached to the handle slider 6 with press-fit dowelpegs 10 as shown or with set screws (not shown) which fit into recesses41 provided in the handle slider 6 (FIG. 2D) and pass through openings46 in each side of the handle release 9. Preferably, the handle release9 also has a ribbed or other non-slip surface 50 which will allow thesurgeon to securely grip the release. A flange 51 also may be providedto assist gripping and retracting handle release 9. Although handlerelease 9 is depicted as U-shaped, the handle release is not limited tothis embodiment and any shape or number of handle releases may beemployed, the shape and number being a matter of ergonomic and/or designpreference.

The handle lock assembly body 7 of handle lock assembly 2 may furthercontain an opening 8, preferably circular as depicted, extendingcompletely through the body from the top 11 to the bottom 12 (FIGS. 2Aand 2C). Retractable slider pin 5 protrudes into opening 8 in the body 7through a side window 13 formed or cut into the side of the opening(best seen in FIG. 2C). This position is referred to as the “extended”position of the retractable slider pin 5.

As shown in FIG. 2C, the body 7 of the handle lock assembly 2 in oneembodiment contains a transition portion 4 as discussed above and ahandle attachment end 15 for connecting the handle lock assembly 2 tothe grasping portion 3 (see also FIG. 1). Preferably, the attachment end15 may be configured for welding to the grasping portion 3 as depicted,but is not limited in that regard. Thus, the handle lock assembly 2 maybe connected to grasping portion 3 in any suitable manner commonly knownin the art including semi-permanent connections such as threading thelock assembly to the handle grasping portion, the use of screws,fasteners, etc. Preferably, the attachment end 15 comprises a taperedcylindrical end designed to be inserted into a hollow handle graspingportion 3 which may be permanently connected to the handle lock assembly2 by welding. As explained above, the handle lock assembly 2 may bedesigned with a minimal or no transition portion 4 of any type, thetransition portion being strictly a matter of design choice. Moreover,enumerable possible shapes for the body 7 of handle lock assembly 2 andaccompanying means of attaching the body to the grasping portion 3 arepossible as will be evident without departing from the inventiondescribed herein; the shape and attachment means being a matter ofdesign choice.

As shown in FIG. 2A, the gripping portion 3 may be angularly displacedfrom the plane of top 11 of the handle lock assembly body 7 as measuredby an angle θ between the top 11 and a longitudinal centerline axis X-Xdrawn through the transition portion 4 (see FIG. 2B). Angle θ ispreferably 0 degrees to 90 degrees, most preferably about 30 degrees.However, it will be readily apparent that angle θ may be varied towhatever angle is desired and necessary depending upon the particularintended surgical application and the configuration of the body 7,transition portion 4, and grasping portion 3 of the handle 1.

In one embodiment shown in FIGS. 2A and 2B, biasing members, which inthis embodiment comprise springs 14, are provided within the handle lockassembly body 7 to hold the handle slider with retractable slider pin 5in the “extended” position wherein the pin protrudes into the circularopening 8. The springs 14 may be confined on one end within recesses 15(best seen in FIG. 2D) made in the handle slider 6. The other end of thesprings 14 may contact the interior wall of the handle lock assemblybody 7 located opposite the recesses 15.

The surgeon operates the handle lock assembly 2 by moving the handlerelease 9 in a direction which retracts the pin 5 from the circularopening 8 against the force of the springs 14. This position is referredto as the “retracted” position of the retractable slider pin 5. When thesurgeon releases the handle release 9, the retractable slider pin 5 isautomatically returned to its initial “extended” position (i.e.,protruding into circular opening 8) by the springs 14. It will beappreciated that the present invention may be constructed with otherforms of biasing members and with only one spring or any number ofsprings, the number and type of biasing members being strictly a matterof design choice.

Although helical springs are depicted, it will further be appreciated bythose skilled in the art that the invention is not limited with regardto the style, size, or spring force constant (k) of the spring orsprings that are used which will depend on the particular intendedapplication. For example, leaf springs, torsion springs, cantileveredbending members, and other biasing members may be used. A spring force(k) should be selected which is sufficient to positively hold theretractable slider pin 5 in the “extended” position described above(i.e., the pin extending into the circular opening 8) to securely holdthe cannula or other surgical instrument in the handle, while at thesame time not being so great that it would be unduly difficult for thesurgeon to retract the pin to the “retracted” position for changing orrotating the cannula or other surgical instrument. The springs 14 may bemade of any suitable material commonly used for such members, and forthe intended application of the device shown should be suitable for asurgical device. It should also be noted that the design of the recesses15 provided in the handle slider 6 maybe varied in any number of ways toaccommodate the specific number, size, and style of biasing membersemployed. Alternatively, the springs 14 may engaged with the handleslider 6 or body 7 by other means commonly known in the art with andwithout the use of any recesses 15 whatsoever. For example, the body 7may contain the recesses or other means to hold the springs 14.

The operation of the handle will be further understood by reference toFIGS. 3A and 3B which depict a cannula that may be used with theinvention. Cannula 16 is a hollow tube-like structure that has acircular cross section comprising a body portion 17 and a head portion18. In one embodiment, an inclined ramp portion 19 is provided whichtransitions the preferably smaller diameter body portion 17 to thelarger diameter head portion 18. The shape of the ramp portion 19 causesthe retractable slider pin 5 to automatically retract when the surgeonpushes the cannula 16 through the circular opening 8 of the handle lockassembly 2, the body portion 17 of the cannula being inserted firstthrough the circular opening 8. This conveniently allows the cannula 16to be inserted into the handle lock assembly 2 without the surgeonhaving to use the handle release 9. However, it should be noted that noramp portion 19 is necessary with the present invention which is notlimited in that regard. Accordingly, the body portion 17 and the headportion 18 may be of the same diameter and the surgeon would use thehandle release 9 to insert the cannula 16 into the handle lock assembly2, as explained more fully below, and then release the handle release tolock the cannula into position.

Still referring to FIGS. 3A and 3B, the cannula, or other surgicalinstrument designed to be used with the handle 1 may be provided withlocking indentations 20. The indentations 20 may be provided around thecircumference of the head portion 18 as shown to mate with theretractable slider pin 5 of the handle lock assembly (FIG. 2A). Theshape and size of the locking indentations 20 may vary and areconfigured to mate with the retractable slider pin 5. In operation, theretractable slider pin 5 engages one of the locking indentations 20 whenthe cannula 16 is in position after it has been inserted through thecircular opening 8 of the handle lock assembly 2 (FIG. 2A). Preferably,the retractable slider pin 5 mates with the indentations 20 in a mannerso that the cannula 16 is positively locked in the handle 1 and cannotbe inadvertently dislodged or withdrawn. Preferably, in order to removeor rotate the cannula, or other surgical instruments that may be used,the surgeon takes the positive step of using the handle release 9 tofirst retract the retractable slider pin 5. A knob 22 is formed on theend of head portion 18 of the cannula 16 and provides a structure forthe surgeon to grasp while inserting or rotating the cannula.Preferably, the knob 22 has a knurled or similar non-slip surface 52.

Operation of the handle 1 of the present invention is best described byreference to FIGS. 2A, 2B, and 3A. The surgeon first selects the propersize cannula 16 for the particular surgical procedure involved. Cannula16 having ramp portion 19 is inserted in the circular opening 8 in thehandle lock assembly 2 of handle 1 until the retractable slider pin 5engages one of the locking indentations 20 of the cannula, therebylocking the cannula in the handle. In this scenario, the ramp portion 19causes pin 5 to automatically retract as described above by insertingthe cannula into the handle 1. Alternatively, if a cannula 16 is usedthat does not have a ramp portion 19 (i.e., the diameter of the cannulabody portion 17 equals the diameter of the head portion 18), the surgeonpreferably first moves the sliding handle release 9 to retract pin 5before inserting the cannula in the handle 2. After the cannula 16 isinserted in the handle 1, handle release 9 is released by the surgeon sothat pin 5 engages one of the locking indentations 20 thereby lockingthe cannula into the handle. This latter procedure of using the handlerelease 9 to retract pin 5 while inserting a cannula 16 may also be usedwith a cannula that has a ramp portion 19. Depending on thecircumferential alignment of the retractable slider pin 5 with thelocking indentations 20 when the cannula is inserted into the handle 1,it may be necessary to turn knob 22 on the head portion 18 of thecannula 16 to rotate the cannula until the pin and one indentationproperly align and are engaged.

To remove cannula 16 from the handle 1, the surgeon moves the slidinghandle release 9 to retract pin 5 and then withdraws the cannula. Thehandle release 9 may also be used in this same fashion to rotate acannula 16 while it is inserted in the handle 1 if the surgeon prefers adifferent rotational position for the cannula.

The cannula 16 in the embodiment shown in FIGS. 3A and 3B may preferablybe provided with accessory depressions 21 which allow other surgicaldevices to be attached to the cannula which may utilize projectionsdesigned to mate with the depressions 21, thereby locking the devices tothe cannula. One such device is a soft tissue retractor, such as cheekC-retractor 49 as shown in FIGS. 4A-4C, which is commonly used inmaxillofacial surgery. The cheek retractor is often used for surgeryinvolving the mandible or jawbone near the ear. In FIG. 4A, the cheekretractor 49 in one embodiment includes locking end portion 29 on oneend of the C-retractor and a forked end portion 30 on the opposite end.Locking end portion 29 further comprises a retractable slider projection31, a projection-carrying slider 32, at least one biasing member whichpreferably is a spring 33 as shown, and press-fit dowel pegs 34. Anopening 36, preferably circular or oval, is also provided in locking endportion 29 along with an open keyway 35, preferably rectangular. Bothopening 36 and keyway 35 extend completely through the locking portion29. Also preferably, the open keyway 35 intersects the opening 36 toform a single contiguous opening wherein sits the retractable sliderprojection 31, projection-carrying slider 32, and spring 33. Theprojection 31 may be attached to the slider 32 in any manner commonlyknown in the art, and may in fact be an integral part of the sliderformed during manufacture of the slider.

Still referring to FIGS. 4A-4C, the retractable slider projection 31 isheld in an “extended” position by the spring 33 whereby the projectionprotrudes into opening 36. One end of spring 33 rests in a recess 43provided in the rear of projection-carrying slider 32 while the otherend of the spring contacts the back wall of keyway 35. The spring forceof spring 33 should be selected to provide sufficient force to holdprojection 31 into the “extended” position, while at the same time theforce should not be so great that it would be unduly difficult for thesurgeon to retract the projection. At least one groove or channel 42 maybe provided in one or both sides of projection-carrying slider 32 whichis closed at the rear near the spring 33. Press-fit dowel pegs 34 may befurnished which ride in the groove or grooves 42 and pass throughopenings 53 in the sides of the locking end portion 29. Alternatively,set screws or other means well known in the art may be used in lieu ofdowel pegs 34. The dowel pegs 34 serve to hold the projection-carryingslider 32 in the locking end portion 29 of the C-retractor 49 bycontacting the closed end of grooves 42 to prevent the spring 33 frompushing the projection-carrying slider into opening 36.

As best seen in FIGS. 4B and 4C, preferably two sliding C-retractorreleases 38 may be provided for retracting slider projection 31 againstthe force of spring 33 to a “retracted” position whereby the projectionis withdrawn from opening 36 into keyway 35. The retractor releases areattached to the top and bottom of projection-carrying slider 32 by anmeans commonly known in the art and may in fact be an integral part ofthe slider 32 formed during the manufacture of the slider. When thereleases 38 are in place, the releases serve as a closure for the topand bottom of keyway 35. The retractor releases 38 preferably have aribbed or other non-slip surface 54 which may be readily gripped by thesurgeon. The retractor releases 38 may also be contoured and shaped toassist a surgeon in retracting the slider projection 31.

The forked end portion 30 of the C-retractor 49 includes two prongs 39;preferably, the prongs are curved away from the C-retractor 49 as shown.Alternatively, the shape of prongs 39 may be straight.

Use of the cheek C-retractor 49 can best be explained by reference toFIGS. 3A and 4A-4C. After the cannula 16 of handle 1 has been insertedthrough a patient's cheek, the forked end portion is inserted through apatient's mouth such that the body portion 17 of the cannula (inside themouth) becomes situated between the two prongs 39. The locking endportion 29 is then affixed to the handle 1 (which is outside thepatient's mouth) by using the sliding retractor releases 38 to retractprojection 31, slipping opening 36 of the C-retractor 49 over knob 22 onthe back of the cannula head portion 18 until the retractable sliderprojection 31 of the C-retractor aligns with one of the accessorydepressions 21 of the cannula, and then releasing the releases 38 toengage the projection in one of the accessory depressions. TheC-retractor is thereby secured to the handle 1. The slider projection 31may also be retracted while the C-retractor 49 remains in position onthe handle 1 in order to rotate the C-retractor to a number of positionsaround and in relation to the handle that may be desired by the surgeon.

Numerous surgical instruments can also be inserted and used through thecannula 16. Referring to FIG. 5, for example, an obturator 55 which iscommonly used in minimally invasive surgical procedures is shown asbeing inserted in the cannula 16. The obturator in the embodimentdepicted consists of a solid round shaft 23 (partially visible at thedistal end of the cannula body portion 17) with a conically pointed tip24 at one end and an enlarged, round head 25 at the opposite end. Theshaft 23 is rigidly attached to head 25 in any manner commonly known inthe art, such as by welding, set screws, threaded attachment, etc. Inthe embodiment shown, the obturator head 25 has at least one tab 26which is designed to mate with at least one slot 27 provided in the knob22 of cannula 16. This prevents the obturator 55 from rotating once ithas been inserted through the cannula 16. Drill guides (not shown) whichare also commonly employed in surgery for fracture fixation may also beused with the cannula 16 of handle 1. These drill guides may be designedto be compatible for use with cannula 16 and may also include at leastone tab on a enlarged, round head like the obturator 55 which mates withat least one slot 27 provided in the knob 22 of the cannula.

FIG. 6 depicts a fully assembled handle 1 with a cannula 16 inserted andlocked in place by the handle lock assembly 2. An obturator 55 is showninserted in the handle 1 with its pointed tip 24 protruding from the endof the cannula 16 and the obturator's enlarged, round head 25 visible atthe opposite end of the cannula.

A tissue retractor system comprising a tubular member, preferably acannula, with a mating tissue retractor member that is rotatably andreleasably engageable with the cannula is shown in FIGS. 7-20. Theretractor member may be used, for example, as a cheek retractor which iscommonly employed in maxillofacial surgical procedures to hold the softcheek tissue away from an operative site on the jaw bone where drilling,implantation of bone screws, and/or other procedures are occurring. Inthe embodiment shown in the foregoing referenced drawings, the retractormember and cannula may be used with the handle 1 disclosed herein;however, use of the retractor member and cannula are not limited in thisregard and the retractor member and cannula may be used with handles ofother design.

Referring to FIGS. 7-10, a retractor member 71, having an outerperiphery that is preferably disk-like or circular in shape, has a topsurface 76, a bottom surface 77, and side surface 78. Other shapes mayalso be used for the retractor member. An opening 75, also preferablycircular in shape and preferably located near the center of theretractor member 71, extends through the retractor member 71 from thetop surface 76 to the bottom surface 77 for receiving a cannula, suchas, for example, the cannula 90 shown in FIGS. 14 and 15. The overallshape of the retractor member 71 is preferably ring shaped. A chamfer 79(best seen in FIG. 9) may be provided at the transition from the topsurface 76 and bottom surface 77 of the retractor member 71 to thecentral opening 75. The size of the opening 75 is preferablycooperatively sized with a cannula 90 to be used with and insertedthrough the retractor member 71, as explained in detail below.

In one embodiment, a ring-shaped retractor member 71 has an outerdiameter of about 17 mm with an opening 75 of about 7 mm in diameter.

One or more holes may be provided in the retractor member 71 to allow asurgeon to hold the retractor member 71 with a surgical instrumentincluding, but not limited to forceps, hooks, or surgical pliers. In oneembodiment shown in FIGS. 7-10, holes 72 may be provided through theside surface 78 of the retractor member 71 to receive the two prongs ofa forceps (not shown), for example, to hold the retractor member 71.Preferably, at least two holes 72 are provided. The holes 72 may extendpartially through the retractor member 71, as shown in FIG. 8, withoutintersecting the central opening 75. Alternatively, the holes 72 may bedeep enough to intersect the opening 75.

A hole 74 may also be provided that passes from the top surface 76 tothe bottom surface 77 of the retractor member 71, as shown, forassisting with the insertion and retrieval of the retractor member froma patient. For example, a hook may be inserted in hole 74 to prevent theretractor member from rotating while the ring is threaded onto thecannula 90. A hook may also be used in hole 74 to retrieve the retractormember 71. Alternatively, a suture may be fastened through hole 74 toassist with retrieving the retractor member 71. The uses for theforegoing holes are described below.

One embodiment of a cannula 90 that may be used with the retractormember 71 is shown in FIGS. 14 and 15. Cannula 90 comprises a bodyportion 91 and a head portion 97. In one embodiment, the cannula 90 isprovided with an inclined ramp portion 95 (whose function is describedabove in connection with FIGS. 3A and 3B) which transitions thepreferably smaller diameter body portion 91 to the preferably largerdiameter head portion 18. However, it will be appreciated that a rampportion 95 is not necessary for operation of the retractor member 71 andcannula 90, and hence need not be provided.

The cannula 90 may preferably be secured to the handle 1 via aretractable slider pin 5 (see, e.g., FIGS. 2A, 2B, and 2E) associatedwith the handle 1 and that engages the cannula. In the embodiment shownin FIGS. 14 and 15, the head portion 97 of the cannula 90 includes acircumferential channel or groove 98 to engage a slider pin 5 (notvisible in FIGS. 7-10) and to secure the cannula 90 to the handle 1. Thegroove 98 is configured and adapted with the pin 5 to allow the cannula90 to be rotated with the cannula inserted in the handle 1, but also topreferably prevent the cannula from moving axially with respect to thehandle 1. The groove 98 is preferably formed in an enlarged boss orportion 105 provided towards the proximal end 110 of the cannula 90.

It should be noted that many types of design approaches may be used tosecure a cannula to a handle, and the handle and/or cannula is notlimited to the use of retractable slider pins in that regard.

The cannula 90 has a longitudinal internal passage 96 that extends froma proximal end 110 (closest to the surgeon) to a distal end 93 (farthestfrom the surgeon and nearest the surgical site). The longitudinalpassage 96 defines a longitudinal axis through the cannula 90. Passage96 is preferably circular in cross-sectional shape and allows varioussurgical instruments (e.g., obturators, drill bits, etc.) and implants(e.g., bone screws, etc.) to be inserted through and used with thecannula 90.

The proximal end 110 of the cannula 90 may have a knob 112. Knob 112,which may be provided with a textured or knurled surface (best seen inFIG. 15) to facilitate grasping by the surgeon, may be used to rotatethe cannula 90 as explained below.

The proximal end 110 of the cannula 90 may have a snap ring 99 (see FIG.14) for securing other surgical instruments, such as an obturator, drillguide, or drill, for example, to the cannula 90.

The distal end 93 of the cannula 90 may have a window 94 that is used toobserve and/or irrigate the surgical site while drilling holes andinstalling screws in the bone.

At least part of the body portion 91 of the cannula 90 preferably hasexternal threads 92 for rotatably and releasably engaging an engagingmember 80 associated with the opening 75 of the retractor member 71. Theengaging member 80 preferably rotatably and releaseably engages thecannula 90. The threads 92 are preferably rounded, but are not limitedin that regard. The external threads 92 may be located anywhere alongthe length of the cannula and is a matter of design choice. Accordingly,the invention is not limited in that regard.

The engaging member 80 may be a pin, screw, or other structure or memberassociated with the retractor member 71 that provides threadableengagement between the threads 92 of the cannula 90 and the retractormember 71. Preferably, the engaging member is a ball tip screw 80 asshown in FIGS. 11 and 12. A threaded hole 73 (see, e.g., FIGS. 8, 9, and13) is provided in the side surface 78 of the retractor member 71 toreceive the ball tip screw 80. The screw 80 has external threads 84 forengaging the threaded hole 73 of the retractor member 71. Threaded hole75 extends completely through the side surface 78 of the retractormember 1 and communicates with the central opening 75. Screw 80 has aconical end 82 terminating in a preferably rounded tip 83 for engagingthe preferably rounded threads 92 of the cannula 90. The tip 83 of screw80 acts as the mating thread for the threads 92 of the cannula 90.Accordingly, the screw 80 is preferably positioned in the threaded hole73 so that the tip 83 of the screw protrudes into the central opening 75of the retractor member 71 a sufficient amount to positively engage thethreads 92 of the cannula 90. During the manufacturing of the retractormember 71, after screw 80 has been inserted to the desired depth in hole73, the screw is preferably affixed permanently to the retractor member71 to hold its position. Fabrication methods such as spot or tackwelding, soldering, stacking, bonding, shrink fitting, etc. may be usedto fix the screw 80 in position.

It should be noted that neither the engaging member, nor hole 75 neednecessarily be threaded, and the invention is not limited in thatregard. Accordingly, other embodiments may be used. For example, hole 75could be unthreaded and an unthreaded pin or similar member could beused.

It should further be noted that the engaging member may be formed as anintegral part of the retractor member. For example, in the embodimentshown in FIGS. 16-19, internal threads 121 may be formed in the centralopening 122 of the retractor member 71 for engaging the threads 92 ofthe cannula 90, thereby eliminating the need for a threaded hole 73 anda separate engaging member such a ball tip screw or pin.

Referring again to FIGS. 11 and 12, the ball tip screw 80 has a toolingend 85 opposite the conical end 82 for engaging a screwdriver or otherdriver to insert the screw into the threaded hole 73 of the retractormember 71. A tool engagement recess, such as slot 81 as shown, isprovided to engage the driver. Although a slot 81 is preferablyprovided, the tool engagement recess may be some other shape such as,for example, a phillips head recess, hex socket, etc.

As shown in FIG. 15, the cannula 90 and retractor member 71 may be usedwith an obturator 100 that has been inserted in the cannula 90. Such anobturator 100 preferably has conical end 101 with a blunt tip 114 (shownnear distal end 93 of the cannula) that extends beyond the end of thecannula 90 when the obturator is fully inserted in the cannula. Theobturator 100 may have a knob 113, which may be similar to the knob 112of the cannula 90. The obturator 100 may be rotationally fixable inposition in relation to the cannula 90 through a locking mechanism, suchas the tab 103 and slot 104 arrangement as shown. With this arrangement,the cannula 90 may be rotated by turning the obturator knob 113.

In a maxillofacial surgical procedure, the retractor member system maybe operated by first inserting the cannula 90/obturator 100 combination(shown in FIG. 15) through a first bodily opening, such as an incisionthat has already been made through the cheek or other part of a patient.With the cannula 90/obturator 100 inserted, the retractor member 71,preferably held by a forceps, surgical pliers, or other tool, may beinserted through a second or other bodily opening and moved toward thecannula 90/obturator 100. For example, the retractor member 71 may be isinserted intra-orally through the open mouth of the patient.Alternatively, the retractor member 71 may be inserted through anopening or portal created by a second incision in the patient. Next, thecentral opening 75 of the retractor member 71 (through which ball tipscrew 80 slightly protrudes) is aligned with and slid over the distalend 93 of the cannula 90/obturator 100 until resistance is met by thethreaded portion 92 of the cannula 90. The cannula/obturator is thenrotated via knobs 112 and/or 113, thereby engaging the retractor member71 with the cannula 90. The cannula 90/obturator 100 is rotated untilthe surgeon achieves the desired degree of cheek retraction so that thecheek does not interfere with the surgical site procedures, such asdrilling holes and inserting screws into the bone. FIG. 20 depicts thecannula 90/obturator 100 with the retractor member engaged thereon.

It should be noted that in lieu of rotating the cannula 90/obturator 100to engage the retractor member 71, the cannula/obturator may be heldstationary and the retractor member may be rotated to engage theretractor member with the cannula. Preferably, the cannula 90/obturator100 is rotated and the retractor member 71 remains substantiallystationary. Also preferably, the retractor member 71 is held.

With the cannula 90 remaining in place and near the surgical site on thebone, the obturator 100 may be withdrawn. Other surgical instruments andimplants, such as drills and bone screws for example, may be insertedand used through the cannula 90 to complete the surgical procedure.

After the surgical procedure is completed, the retractor member 71 isonce again grasped with a forceps or surgical pliers, and the cannula 90is rotated to unscrew and remove the retractor member 71 from thecannula. The retractor member 71 is then retrieved from the patientthrough the second bodily opening.

Because either the retractor member or the cannula may be rotated tothread the retractor member onto the cannula, it will be apparent that aretractor member of any desired shape may be used. Accordingly, althougha circular or ring-shaped retractor member is preferred, the retractormember may be configured to suite a particular type of surgicalprocedure.

It should be noted that although a maxillofacial surgical procedure hasbeen described above, the retractor system may be used in any type ofsurgical procedure where tissue retraction is desired.

The handle including all of the forgoing components described (i.e., thecannula, obturator, drill guides, C-retractor, retractor member, etc.)may be constructed of any material suitable for use in surgicalprocedures. For example, the handle and its components may preferably bemade of stainless steel which is commonly used; however, the inventionis not limited in the type of materials employed which would be a matterof design choice.

It will be appreciated by those skilled in the art that the details ofthe handle and all of the foregoing components described herein are amatter of design choice, and that the invention is not limited to theparticular embodiments or those features described. Accordingly,numerous modifications may be made to the handle and its componentswithout departing from the spirit of the invention and scope of theclaims appended hereto.

1. A surgical retractor system comprising: an elongated tubular member;a retractor member having a side surface and an opening configured andadapted to receive the tubular member, and an engaging member receivedin the side surface of the retractor, wherein the engaging memberengages the tubular member; wherein rotation of one of the tubularmember and the retractor member rotatably engages the retractor with thetubular member.
 2. The system of claim 1 further comprising the tubularmember having external threads disposed on at least part of the tubularmember for rotatably engaging the engaging member of the retractor. 3.The system of claim 1 wherein the engaging member is disposed in a borein the side surface of the retractor member, the bore extending from anouter surface of the retractor member to and in communication with theopening in the retractor member.
 4. The system of claim 2 wherein theengaging member has a blunted tip protruding at least partially into theopening of the retractor member for engaging the external threads of thetubular member.
 5. The system of claim 2 wherein the engaging membercomprises a screw and the retractor member has a threaded holecommunicating with the opening of the retractor member, the screw beingdisposed in the threaded hole.
 6. The system of claim 2 wherein theengaging member comprises threads disposed on the retractor memberadjacent the opening for receiving the tubular member, the threads ofthe retractor member engageable with the threads of the tubular member.7. The system of claim 1 further comprising the tubular member having aknob for rotating the tubular member.
 8. The system of claim 1 whereinthe tubular member is a cannula.
 9. The system of claim 1 wherein theretractor member is shaped substantially like a ring.
 10. The system ofclaim 1 further comprising the retractor having at least one holeconfigured to engage at least part of a surgical instrument formanipulating the retractor member.
 11. A cheek retractor systemcomprising: a cannula having threads disposed on at least a portion ofthe cannula; a retractor member having a side surface and an openingthrough the retractor member for receiving the cannula; and an engagingmember positioned within the side surface of the retractor member, theengaging member rotatably engaging the cannula.
 12. The system of claim11 wherein the engaging member is a screw having a tip, the tip of thescrew protruding at least partially into the opening of the retractorfor engaging the cannula.
 13. The system of claim 11 wherein theengaging member comprises threads disposed on the retractor memberadjacent the opening for receiving the tubular member.
 14. The system ofclaim 11 further comprising the cannula having a distal end, a proximalend, and a window at the proximal end for facilitating observation orirrigation of the surgical site.
 15. The system of claim 11 furthercomprising the retractor member having a top surface, a bottom surface,and at least one hole extending at least partially through the sidesurface for engaging part of a surgical instrument to manipulate theretractor member.
 16. The system of claim 15 further comprising at leastone hole extending from the top surface to the bottom surface of theretractor member for manipulating the retractor member.
 17. The deviceof claim 11 further comprising at least two holes extending at leastpartially through the retractor member, the at least two holes eachconfigured to receive part of a tool for manipulating the retractormember.
 18. The device of claim 11 wherein the engaging member comprisesa tip protruding at least partially into the retractor member opening.19. The device of claim 18 wherein the engaging member is a screw thatis threadably connected to the retractor member.
 20. The device of claim18 wherein the engaging member is a pin.
 21. The device of claim 18wherein the engaging member comprises threads disposed in the retractoropening. 22-38. (canceled)
 39. A retractor system for insertion in abody for contacting and moving body tissue comprising: an elongatedtubular member made of a biologically compatible material; and aretractor member having a surface for contacting body tissue and anopening configured and adapted to receive the tubular member, theretractor member further having an engaging member for engaging thetubular member, wherein rotation of one of the tubular member and theretractor member rotatably engages the retractor with the tubularmember.